Designing a better NHS does not look like the US version
December 5, 2011
Laurie Penny writes
I first came to New York to write about the emerging social justice movements associated with Occupy Wall Street. Through my conversations with the protesters in Zucotti Park, I began to understand how profoundly the stranglehold of American private healthcare keeps ordinary people cowed and compliant in the land of the notionally free.
It’s not just the 59 million Americans living without health insurance and unable to access treatment for everyday maladies without crippling expense. It’s the millions more who dare not risk a dispute with their boss for fear of losing their medical cover, who expect to remortgage their homes in old age to meet the costs of failing health, or who live in fear of bankruptcy should they develop a chronic condition or have an accident.
The notion of a society that sanctions companies to profit from sickness feels barbaric enough, without then forcing ordinary people to choose between medical treatment and the financial future of their families. President Obama’s attempt to reform the system in 2009 roundly failed to remove healthcare as a source of perennial anxiety for most American citizens, or to lighten the dead hand of the market on medical provision in the US.
Chatting last night to a clinician friend – we were discussing the No Straight Lines project, in the context of healthcare.
We can see that things could be done better – but the question is HOW? Is it right to use free market thinking as an invasive form of ideology into all aspects of the fabric of British Society? My view is that its a form of toxic creep. Cameron stated he would, and I quote verbatim, ‘that his government would ring-fence the NHS’. It hardly looks like that to me. Also, because of the research conducted over the last 7 years on No Straight Lines, we can see that people like Andrew Lansley and this government, are struggling with complexity, and trying to take an old model which has failed and attempting to apply that to a new paradigm. The fact is there are enough great answers to these problems which in fact are far superior in the service they deliver, at a fraction of the cost but are in Lansley’s view unorthodox, so therefore cannot be looked at seriously. As John Berger wrote in Ways of Seeing, “what you see is defined by what you know.”
Not far from where Andrew Lansley lives is Cambridge, there is some very interesting innovation happening in healthcare in Cambridge. For example Patients Know Best enables people managing long term chronic healthcare to engage in a more meaningful dialogue with clinicians, which can deliver far better, for far less, and avoid wastage in unnecessary hospital visits which happen for a whole host of reasons. in Ontario, through a Participatory Leadership programme, the entire community and healthcare system are engaged as participants in working on evolving a more relevant form of healthcare service – without the need for consultants, with their flip charts and powerpoint decks. (more on this in the No Straight Lines book). This is an entirely different form of innovation, that has an entirely different though common sense approach to solving wicked problems.
In No Straight Lines we look at the problems of a US led style healthcare system, its unfairness and its entire design based upon procedures done to patients (which is how private companies make their money). More procedures = more money. Its machine age thinking, its linear, its not networked, nor design led. Its not human centric, its money centric.
In a paper I received recently entitled: Liberating the NHS: source and destination of the Lansley reform
The authors write, The Financial Times Public Policy Editor has noted of the current NHS reform:
“what is still missing is a narrative that explains how these changes, carried out in this way at this time, will help the NHS to address its central task – making £20bn of efficiency savings over the next four years in order to meet rising demand within a budget that is flat in real terms. Instead, the opposite is more likely.”
A narrative for this reform, far more transparent than the double-speak of the White Paper, can indeed be located. It is described in the following pages. It maps a move away from the tax-funded NHS based on the principles of contribution according to ability to pay, and use according to medical need. It takes the NHS towards a US-style arrangement of individual health insurance with access to care based on payment of health insurers at a level based on the insuree’s state of health. In other words it removes the pooling of risk which underlies the post-war social solidarity compact, involving subsidy of health care for poorer and less healthy citizens by richer and healthier compatriots. A plan for the end-state system to be jointly funded by the state and the individual solves the perplexing riddle of how the new system could generate £20 billion of savings, given that it involves more providers, fragmented procurement, more complex administration, the marketing costs involved in market competition, and multiple layers of profit extraction from the NHS budget,. Cost reductions will be achieved through de-skilling and poorer employment terms for medical professionals as the NHS hospitals which employ them are shifted into the private sector.
You can read the rest here – and share it with those that you believe should be reading it.
5 non-linear ways to think differently about healthcare
- Preventative medicine is crucial to reducing costs of NHS which means tackling the causes of Diabetes, and other forms of chronic health brought on by poor diet and a fast food culture
- Better, much better does not necessarily cost the earth
- but it is about literacy and design thinking
- We need to design around patient empowerment
- And we must design for transformation, to be lightweight, flexible – and in a constant process of iteration